establish a new national independent Aged Care Quality and Safety Commission, starting from 1 January 2019, which will bring together the functions of the Australian Aged Care Quality Agency, the Aged Care Complaints Commissioner and the aged care regulatory functions of the Department of Health

increase transparency through a publicly available rating against quality standards

appoint a new Chief Clinical Advisor to provide advice to the Commission, particularly on complex clinical matters, including the misuse of physical and chemical restraints

consult with the sector on the introduction of a Serious Incident Response Scheme.

However Wyatt publicly rejected calls from the nursing union and elsewhere for mandating staff-resident ratios, telling media there wouldn’t be sufficient staff for small country towns or remote Aboriginal communities and commenting that mandating ratios in childcare had increased the costs for families.

The federal reforms are in response to last year’s Carnell-Paterson review into how Commonwealth aged care quality regulatory processes “failed to adequately detect the longstanding failures in care” at Oakden.

Announcing the federal reform, Wyatt said the new Commission will be “a responsive, one-stop shop to prevent failures, highlight quality concerns and have them quickly rectified”. It will build, he said, on the recent introduction of unannounced re-accreditation audits across every one of Australia’s residential aged care facilities. He said:

“Importantly, the new Commission will give senior Australians and their loved ones a single point of contact when they need help in dealing with claims of sub-standard care.

“Risks to senior Australians will be investigated promptly and care failures identified faster.”

There have been mixed responses to the package – see a number of them below.

Croakey readers may also be interested to read about this new study by researchers at UNSW Medicine’s Centre for Healthy Brain Ageing (CHeBA), the Department of Aged Care at St George Hospital, and Calvary Health Care on ways to reduce hospital readmissions from aged care.

Published in the March issue of JAMDA, it found that an intervention approach that involves structured visits to healthcare professionals for nursing home residents after hospital discharge halves their chance of readmission and visits to emergency rooms.

The researchers said the findings highlight the importance of follow through care of nursing home patients after hospital discharge, “an aspect of care generally neglected in this group”.

Consumers Health Forum

Consumers Health Forum CEO Leanne Wells welcomed the establishment of the independent Aged Care Quality and Safety Commission and increased transparency on quality standards, particularly the introduction of truly unannounced visits “as providing a real snapshot of the care that is provided”.

But she said the reforms must be backed by stronger standards and more resources:

“We hope that the new Commission will see the value of having consumers as part of the accreditation and inspection teams as they can help frame discussions with consumers about their real experience of care.

“It is also clear that without better resourcing and staffing, many nursing homes will continue to struggle to provide the care we would expect for older Australians.”

Aged care expert Sarah Russell

Writing at Guardian Australia, Dr Sarah Russell said the merging of a number of agencies to form the Aged Care Quality and Safety Commission, rather than tackling “disgracefully inadequate staffing requirements” amounted to ” shifting the deckchairs on the Titanic”.

Russell called for a review of the 20 year old Aged Care Act 1997, delivered under the Howard Government, which she said marked a turning point for aged care in Australia, in particular, increasing private investment in the residential aged care market and complete absence of any obligation on facilities to “take proactive measures to promote mental health and wellbeing of their residents”.

She called for greater access to data on residents’ safety and wellbeing in aged care homes and to mandate staff-resident ratios in aged care homes. She said:

Staffing studies undertaken in the United States, Canada, United Kingdom, Germany, Norway and Sweden show that the ratio of registered nurses-to-residents has a positive impact on the standards of care in an aged care home. Wyatt ignores this empirical evidence.

Council of the Ageing

The peak body for older Australians and aged care consumers, COTA Australia, welcomed the announcement of the Commission as “another significant step towards better monitoring and enforcement of quality in Australia’s aged care system, together with the new regime of unannounced visits by quality assessors”.

However CEO Ian Yates said the government still needs to go further and give consumers direct control over their aged care funding, as recommended by several inquiries and this government’s own aged care advisory body.

COTA also pointed out that the Carnell/Paterson inquiry also included a recommendation for the appointment of a “Consumer Commissioner” in the new Commission, to develop processes to ensure consumers and families receive full information about their rights and are supported and protected to exercise those rights.

“The atrocities at Oakden were only brought to light thanks to the tenacity and persistence of Oakden family members, demonstrating the importance of having strong consumer voices heard in aged care quality processes, but we need to make it much easier, indeed normal practice, for consumers and families to be involved – that’s why we need the Consumer Commissioner’s role.”

National Seniors

National Seniors Australia also welcomed the creation of a new watchdog for the industry, with a single point of contact, and greater transparency around standards.

In a statement, National Seniors Australia Chief Advocate Ian Henschke said putting all the functions of three different aged care bodies into one could be a challenge but if well implemented, it should lead to better monitoring and early detection of quality of care issues.

“We look forward to working with the government on developing the performance rating system as well as a Serious Incident Response Scheme and a user-friendly comparison tool on the My Aged Care website.”

Mr Henschke said National Seniors had previously called for greater support for quality assessors by allowing them more time for evidence gathering as part of the aged care facility accreditation processes.

“We would also like to see the new commission use its broader functions to identify and implement practical changes that would improve the quality of care for all older Australians, so they receive the kind of care they deserve,” he said.

Australian Medical Association (AMA)

In a statement marking the release of the AMA’s Position Statement on Resourcing Aged Care, Vice President Dr Tony Bartone welcomed the decision to establish an Aged Care Quality and Safety Commission, which he said was consistent with the AMA’s call for an independent Aged Care Commissioner and a core part of the Position Statement.

However while the Commission was “a good start”, much more needed to be achieved to ensure older Australians receive the care they need and deserve in their later years, he said.

The Position Statement outlines the workforce and funding measures that the AMA believes are required to achieve a high quality, efficient aged care system that enables equitable access to health care for older people. Key recommendations include:

More Government funding and support to allow ongoing access to medical and health care at home so people can remain in their home for as long as is appropriate. At the end of 2017, there were 104,602 older people waiting for an appropriate home care package, the majority of whom have high care needs.

Improved access for older people in residential aged care facilities (RACFs) to doctors through enhanced Medical Benefits Schedule (MBS) funding, and research into improved models to facilitate medical care in RACFs. Currently, the AMA said, inadequate MBS funding is a barrier for GPs to attend residents of aged care facilities, as they do not compensate for the significant non-face-to-face time (travel, finding residents and staff, etc.) that comes with caring for RACF residents.

Improved Accreditation Standards, which should include a satisfactory registered nurse to resident ratio in RACFs. The AMA said there has been a decreasing trend in the proportion of registered and enrolled nurses in the residential aged care workforce.

Bartone said that AMA members have reported cases where nurses are being replaced by junior personal care attendants, and some residential aged care facilities do not have any nurses on staff after hours. He said:

“It is unacceptable that some residents, who have high care needs, cannot access nursing care after hours without being transferred to a hospital Emergency Department.

He said the aged care needed more full time nurses, greater incentives for doctors to attend aged care facilities on a more regular basis to meet demand and ensure quality medical care, and enforceable standards that require facilities to provide clinically-equipped doctor treatment rooms that are readily available for use by doctors and nurses, with access to patient files, in existing and future residential aged care facilities.

Federal Opposition

Shadow Minister for Ageing and Mental Health Julie Collins welcomed the reform plan but criticised the government for having sat on the Carnell-Paterson review since last October, as well as “more than a dozen” other relevant reports.

“We know that this Government has three Ministers in five years for aged care. We know that it has ripped billions out of the aged care system. What we need to see from the Government in the upcoming Federal Budget is more action on both this report and other reports, but also more investment into aged care. We have now, in Australia, more than 100,000 Australians sitting on a waiting list for home care packages. We think it’s about time the Government dealt with this issue and I’ll continue to put pressure on the Government to do so.

Other media reports

This week’s aged care reform continues the tradition of federal governments tinkering at the edges of the heavily regulated and mostly taxpayer-funded sector, but putting off a major overhaul of its old-fashioned funding model.

About Croakey

Croakey is a social journalism project that enables debate and investigations of health issues and policy. We connect, collaborate, and evolve.
We pay our respects to the Traditional Custodians of the country where we live, work and travel upon, and to the Elders, past, present and future.
Read more here.

Contact Croakey

Get croakey things

More info

What others say

It is polite and political, informative and inspiring. Active engagement is what Croakey does – and I like it!

Professor Kerry ArabenaChair of Indigenous Health, The University of Melbourne

If news doesn’t make you squirm it’s simply propaganda. Croakey’s unique blend of activism, humour and plain good reporting makes it an essential - if not always comfortable - read!

Professor Virginia BarbourExecutive Officer, Australian Open Access Support Group, Chair, COPE, Professor, School of Medicine, Griffith University

Croakey is an important part of the health landscape providing progressive, current and incisive commentary.

Professor Fran BaumProfessor of Public Health, Flinders University

Croakey is terrific. Thought provoking, well researched information….and easy to read. A great combination.

Professor Kate ConigraveProfessor Addiction Medicine, The University of Sydney

Croakey has been a platform which has encouraged Aboriginal voice and actively sought it out. I started out as a reader, then followed on Twitter, was a guest tweeter on @WePublic health, and have become a contributor.

Croakey is now well established as compulsory reading for influencers and observers in health and medicine in Australia and internationally – and rightly so.

John FlanneryPublic Affairs Director, Australian Medical Association

Croakey provides an informed voice to the health, equity and environmental debates, and is helping mobilise the necessary political and popular support for a radical break from the complacent and compartmentalized attitude that still dominates much of the political agenda.

Professor Sharon FrielDirector and Professor of Health Equity Regulatory Institutions Network (RegNet), Director, Menzies Centre for Health Policy, The Australian National University

From a crowded inbox, Croakey always leaps to my attention. It delivers views and information on a wide range of issues of relevance to rural and remote health and wellbeing.

Gordon GregoryNational Rural Health Alliance

Croakey is health media rather than medical media. You should be reading it every day if you're interested in health services or population health.

Ben Harris-RoxasZEST Health Strategies

Croakey provides snappy, expert views on the whole spectrum of public health issues, from equity to efficiency, from determinants to prevention to management.

Professor Jon KarnonSchool of Population Health, University of Adelaide; President of the Health Services Research Association of Australia and New Zealand

Croakey has served splendidly as an independent voice in the health policy arena.

Emeritus Professor Stephen LeederThe University of Sydney

Time and again I go to Croakey to understand the politics behind public health because Croakey sorts the wheat from the chaff.

Dr Mark LockResearch Fellow, The University of Newcastle

I love the context and clarity that Croakey's contributors bring to very complex issues. And the merch.

Marie McInerneyjournalist, editor, Croakey moderator

Croakey has pioneered an unprecedented role in providing an open forum for the revelation and exchange of thinking on health in Australia.

Mark Metherellhealth journalist, CHF

Croakey - like a sore throat spreading amongst friends - helps to spread healthy ideas rapidly through the blog and the Twittersphere. Thank you Croakey.

Michael MoorePublic Health Association of Australia

Croakey - Australia's healthiest news-site!

Former MP, Rob Oakeshott

If you work in the health area – and especially if you are a policy wonk, a political nerd, or a news fiend – then Croakey Blog is an essential component of your life.

Lesley RussellAdj Assoc Professor at Menzies Centre for Health Policy, University of Sydney, Visiting Fellow, Australian Primary Health Care Research Institute, Australian National University

The diversity of authors and timeliness of posts are very much appreciated. Bring me more of this!

One of my favourite things about Croakey is the active engagement of so many people with a passion for equity and public health.

Melissa Sweetpublic health journalist, Croakey founder, PhD candidate

Croakey cuts through health care professional and organisational interests with edgy critiques about the diverse communities they are there for. In other words, you call BS on those with self interest.

Jason TrethowanCEO PHN Western Victoria

Croakey is a must for anybody looking to stay on the cutting edge of health news.

Alison VerhoevenAustralian Healthcare and Hospitals Association

So happy to be creating and coding for such a dedicated, professional and good-humored team.

Mitchell WardArtistic Director of Rock Lily Design and Croakey

If you care about a public health issue, or want others to care, get it online and get it on Croakey.

Croakey is a space that invites us to to challenge and interrogate our practice and our policy.

Mary FreerChange Day Australia

Croakey is a valuable voice in the health space

Catherine KingShadow Minister for Health

Croakey is a must read for anyone who craves the public health stories that no one else reports.

Dr Becky FreemanSydney School of Public Health, University of Sydney

We love the difference Croakey makes to the health conversation in Australia.

Professors Marc Tennant, Estie Kruger and Kate Dyson International Research Collaborative, Oral Health and Equity, The University of Western Australia.

The broad mix of contributors, topics and prolific tweets combine to make it a valuable and lively source of news and food for thought for all Australians.

Shauna Hurley Communications Manager, Cochrane Australia School of Public Health and Preventive Medicine, Monash University

Croakey is the platform where health issues are dissected from every angle – from the complex impact on health arising from social, economic and environmental policies, to the influence of vested interests on public health, and insightful analysis of health care policies.

Marita Hefler Researcher, News Editor, BMJ Tobacco Control

Croakey gives me the best independent and most relevant public health news and views.

Croakey has, over some years, provided a platform for debate about health policy, planning, funding and services. There aren’t enough places for these debates, and important issues affecting the health of our community risk going unexplored. Croakey helps to fill this hole.

Croakey is one of the few places where public health "activists" can vent their spleen...It's also a useful place for journalists/media to find contacts who can speak intelligently on public health issues.

Dr Rosemary Stanton OAM Public health nutrition "activist"

Intelligence and thoughtfulness are pre-requisite foundations for a civilised society’s media, and Croakey rises above the mundanity of most Australian efforts to remind us that smart, switched-on writers and thinkers are still out there